Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Viruses. 2024 Sep 5;16(9):1416. doi: 10.3390/v16091416.
Hepatitis C virus (HCV) infection and hazardous alcohol use are both preventable causes of morbidity and mortality among people who inject drugs (PWID). In the general population, hazardous alcohol is associated with a reduced likelihood of HCV treatment initiation. Less is known about the prevalence and impact of hazardous alcohol use on direct-acting antiviral (DAA) therapy initiation among PWID with active injection drug use.
PWID were recruited via street outreach in Baltimore, Maryland, between 2018 and 2019 and were enrolled in a study cohort. Participants completed a study survey and underwent HCV testing. Self-reported DAA therapy initiation was evaluated at follow-up visits every six months. Hazardous alcohol use was determined based on an AUDIT-C score of ≥4 for men or ≥3 for women. Data were analyzed using multivariable logistic regression with generalized estimating equations.
Of the 720 PWID recruited, 291 had detectable HCV RNA, and only 134 were aware of their HCV infection. The mean (±standard deviation) age of those that were aware of their infection was 48.7 (±10.3) years, with a slight majority (53.0%) being male and predominantly African American (64.9%). The majority (80/134, 59.7%) met criteria for hazardous alcohol use. Only 16 (11.9%) PWID reported DAA therapy initiation within six months, and 20 (14.9%) reported it within 12 months of follow-up. Hazardous alcohol use (aOR = 1.23, 95% CI = 0.43-3.53) was not associated with DAA treatment initiation.
There was a high prevalence of hazardous alcohol use, low rates of oral DAA therapy initiation, and no association between self-reported hazardous alcohol use and initiation of oral DAA therapy in our sample of PWID that were aware of their chronic HCV infection. Strategies to increase HCV treatment uptake in PWID with active drug use are urgently needed and should integrate alcohol and drug use evaluation and care.
丙型肝炎病毒（HCV）感染和危险饮酒都是导致吸毒者（PWID）发病和死亡的可预防原因。在普通人群中，危险饮酒与 HCV 治疗开始的可能性降低有关。在持续使用注射毒品的 PWID 中，关于危险饮酒对直接作用抗病毒（DAA）治疗开始的影响的了解较少。
2018 年至 2019 年期间，通过巴尔的摩的街头外展招募了 PWID，并将他们纳入了一个研究队列。参与者完成了一项研究调查，并接受了 HCV 检测。在每六个月一次的随访中评估自我报告的 DAA 治疗开始情况。根据 AUDIT-C 评分男性≥4 分或女性≥3 分确定危险饮酒。使用广义估计方程的多变量逻辑回归分析数据。
在招募的 720 名 PWID 中，有 291 名可检测到 HCV RNA，只有 134 名知晓自己的 HCV 感染。知晓自己感染的人的平均（±标准差）年龄为 48.7（±10.3）岁，略多数（53.0%）为男性，主要为非裔美国人（64.9%）。大多数（80/134，59.7%）符合危险饮酒标准。只有 16 名（11.9%）PWID 在 6 个月内报告开始 DAA 治疗，20 名（14.9%）在 12 个月的随访内报告开始 DAA 治疗。危险饮酒（比值比=1.23，95%置信区间=0.43-3.53）与 DAA 治疗开始无关。
在知晓自己慢性 HCV 感染的 PWID 中，危险饮酒的流行率很高，口服 DAA 治疗的开始率很低，且自我报告的危险饮酒与口服 DAA 治疗的开始之间没有关联。迫切需要采取策略来增加活跃吸毒者的 HCV 治疗参与度，并且应该将酒精和药物使用评估和护理纳入其中。
